Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.

nàlisi de les modificacions produïdes per llops en conjunts ossis actuals a Bialowieza i Biezcady (Polonia)

Projecte de recerca elaborat a partir d’una estada a la Université Toulouse-Le Mirail, França, entre octubre i novembre del 2006. Estudi experimental que s’emmarca en un projecte predoctoral que té com a objectius principals caracteritzar les modificacions produïdes per carnívors en conjunts ossis actuals, establir una metodologia que permeti identificar el predador o predadors que han intervingut i aplicar aquesta metodologia al registre arqueològic. S’han analitzat les modificacions produïdes per llops (Canis lupus) en conjunts ossis actuals procedents del Parc Nacional de Bialowieza y Biezcady a Polonia i que formen part de la neotafoteca amb dipòsit a la Universitat de Toulouse. L'anàlisi de les fractures i les mossegades als ossos fetes pels llops (Canis lupus) durant el consum, han revelat la important capacitat destructiva i modificadora d'aquests agents tafonòmics. Les dades obtingudes, d'aquest i altres estudis, serviran per confeccionar una metodologia vàlida per a l’estudi de la intervenció de llops en conjunts arqueològics. També serà possible crear un model del tipus de modificació que produeixen els llops. Aquest model estarà reforçat per experiments realitzats per altres investigadors i es podran aplicar als estudis tafonòmics de jaciments arqueo-paleontològics.

Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis.

BACKGROUND: A single infusion of intravenous zoledronic acid decreases bone turnover and improves bone density at 12 months in postmenopausal women with osteoporosis. We assessed the effects of annual infusions of zoledronic acid on fracture risk during a 3-year period. METHODS: In this double-blind, placebo-controlled trial, 3889 patients (mean age, 73 years) were randomly assigned to receive a single 15-minute infusion of zoledronic acid (5 mg) and 3876 were assigned to receive placebo at baseline, at 12 months, and at 24 months; the patients were followed until 36 months. Primary end points were new vertebral fracture (in patients not taking concomitant osteoporosis medications) and hip fracture (in all patients). Secondary end points included bone mineral density, bone turnover markers, and safety outcomes. RESULTS: Treatment with zoledronic acid reduced the risk of morphometric vertebral fracture by 70% during a 3-year period, as compared with placebo (3.3% in the zoledronic-acid group vs. 10.9% in the placebo group; relative risk, 0.30; 95% confidence interval [CI], 0.24 to 0.38) and reduced the risk of hip fracture by 41% (1.4% in the zoledronic-acid group vs. 2.5% in the placebo group; hazard ratio, 0.59; 95% CI, 0.42 to 0.83). Nonvertebral fractures, clinical fractures, and clinical vertebral fractures were reduced by 25%, 33%, and 77%, respectively (P<0.001 for all comparisons). Zoledronic acid was also associated with a significant improvement in bone mineral density and bone metabolism markers. Adverse events, including change in renal function, were similar in the two study groups. However, serious atrial fibrillation occurred more frequently in the zoledronic acid group (in 50 vs. 20 patients, P<0.001). CONCLUSIONS: A once-yearly infusion of zoledronic acid during a 3-year period significantly reduced the risk of vertebral, hip, and other fractures. (ClinicalTrials.gov number, NCT00049829.)

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Developing a predictive understanding of subsurface flow and transport is complicated by the disparity of scales across which controlling hydrological properties and processes span. Conventional techniques for characterizing hydrogeological properties (such as pumping, slug, and flowmeter tests) typically rely on borehole access to the subsurface. Because their spatial extent is commonly limited to the vicinity near the wellbores, these methods often cannot provide sufficient information to describe key controls on subsurface flow and transport. The field of hydrogeophysics has evolved in recent years to explore the potential that geophysical methods hold for improving the quantification of subsurface properties and processes relevant for hydrological investigations. This chapter is intended to familiarize hydrogeologists and water-resource professionals with the state of the art as well as existing challenges associated with hydrogeophysics. We provide a review of the key components of hydrogeophysical studies, which include: geophysical methods commonly used for shallow subsurface characterization; petrophysical relationships used to link the geophysical properties to hydrological properties and state variables; and estimation or inversion methods used to integrate hydrological and geophysical measurements in a consistent manner. We demonstrate the use of these different geophysical methods, petrophysical relationships, and estimation approaches through several field-scale case studies. Among other applications, the case studies illustrate the use of hydrogeophysical approaches to quantify subsurface architecture that influence flow (such as hydrostratigraphy and preferential pathways); delineate anomalous subsurface fluid bodies (such as contaminant plumes); monitor hydrological processes (such as infiltration, freshwater-seawater interface dynamics, and flow through fractures); and estimate hydrological properties (such as hydraulic conductivity) and state variables (such as water content). The case studies have been chosen to illustrate how hydrogeophysical approaches can yield insights about complex subsurface hydrological processes, provide input that improves flow and transport predictions, and provide quantitative information over field-relevant spatial scales. The chapter concludes by describing existing hydrogeophysical challenges and associated research needs. In particular, we identify the area of quantitative watershed hydrogeophysics as a frontier area, where significant effort is required to advance the estimation of hydrological properties and processes (and their uncertainties) over spatial scales relevant to the management of water resources and contaminants.

Structures and failure mechanisms analysis of Turtle Mountain

The 30 M m3 rockslide that occurred on the east face of Turtle Mountain in the Crowsnest Pass area (Alberta) in 1903 is one of the most famous landslides in the world. In this paper, the structural features of the South part of Turtle Mountain are investigated in order to understand the present-day scar morphology and to identify the most important failure mechanisms. The structural features were mapped using a high resolution digital elevation model (DEM) in order to have a large overview of the relevant structural features. At the same time, a field survey was carried out and small scale fractures were analyzed in different parts of southern Turtle Mountain in order to confirm the DEM analysis. Results allow to identify six main discontinuity sets that influence the Turtle Mountain morphology. These discontinuity sets were then used to identify the potential failure mechanisms affecting Third Peak and South Peak area.

Efectos de lo real. Discursos acerca de los cuerpos artificiales

Los cuerpos artificiales ( muñecos, autómatas, maniquíes) son tratados a través de tres tipos de discurso: del artificio, de la mirada y del deseo. Esta perspectiva permite abordarlos, no como representaciones ni como dobles (Döppelgänger) sino como significantes en el discurso , como objetos de deseo y como puntos de articulación de la mirada. En el discurso del artificio se pasa revista al binomio natural/artificial y , a través de distintos textos , El tratado de Hombre de René Descarrtes, la “teoría de los maniquíes” y la “generatio aequivoca” de Bruno Schulz, y el film Jidlo (Comida) de Jan Svankmajer, se hace lo propio con los paradigmas desde los que se ha metaforizado al cuerpo humano. En el discurso de la mirada, se los aborda desde la perspectiva psicoanalítica del campo escópico, a través de El hombre de la arena, de ETA Hoffmann. Los discursos del deseo tratan de algunos aspectos de esta pulsión : el deseo masculino desde La Eva futura de Villiers de l’Isle Adam, el “deseo de hijo”, a través del film Otesánek de Jan Svankmajer y la genericidad del deseo en dos novelas de Gaston Leroux , La muñeca sangrienta y la máquina de asesinar . Los cuerpos artificiales, así, podrían ser considerados, en su potencia significativa, no ya como dobles , sino como efectos de lo real, como “pequeños otros”, como “objetos a” lacanianos y como simulacros.

Nouveautés en médecine ambutatoire: dépistage, traitement et iatrogénicité [Innovations in ambulatory care: screening, treatment and iatrogenicity]

Cette année, six études utiles pour la pratique ont été retenues. L'indication à la mammographie entre 40 et 49 ans devrait être évaluée individuellement et en tenant compte des risques/bénéfices de cet examen. Au-delà de 65 ans, un dépistage systématique de la fibrillation auriculaire avec prise de pouls puis ECG (si pouls irrégulier) pourrait être réalisé de manière systématique. Les risques de complications postcolonoscopie existent, particulièrement suite à des biopsies/polypectomies, et ce risque devrait être discuté. Les inhibiteurs de la pompe à protons au long court sont un facteur de risque de fracture de hanche. S'il est important de prendre en charge des pressions artérielles élevées au-delà de 80 ans, il faut être prudent (orthostatisme). Une corticothérapie précoce suite à une paralysie faciale périphérique est efficace. This year we have selected six studies useful for the day to day practice. A mammography in women 40 to 49 years of age should be evaluated taking into account the patient's profile and the possible risks and benefits of this exam. In patients over 65 years of age, a systematic atrial fibrillation screening, with pulse rate measuring then ECG (if irregular beat) should be realised on a regular basis. The risks for complications following colonoscopies do exist, especially after biopsies/polypectomies and this risk should be discussed. Long term proton pump inhibitor treatment is a risk factor for hip fracture. It is important to treat high blood pressure problems in the elderly, but the orthostatic risks should be adressed. A corticoid treatment started quickly for Bell's palsy is efficient

Pseudarthroses aseptiques des os longs [Pseudarthrosis of the long bones].

5 to 10% of all fractures present with a delayed union, whereas 1 to 5% progress to a nonunion, which can be defined as a fracture older than 6 months and lacks any potential to heal without any further intervention. Different fracture and patient related risk factors exist, and the management of a nonunion needs a thorough clinical, radiological and biological workup to classify them in one of the two main categories, the viable nonunions that need essentially more stability, usually by a more rigid fixation, and the non-viable nonunions that need essentially a biological stimulation by decortication and bone grafting. This treatment still remains the first choice with bony healing obtained in 85 to 95% of cases, but it also comes along with certain risks, and some valuable alternatives exist if chosen on the basis of rigid criteria.

Prophytaxie de l'ostéoporose cortisonique: qui, quand et quoi [Prevention of cortisone-induced osteoporosis: who, when and what?]

Glucocorticoid-induced osteoporosis is a known phenomenon with already an increased fracture risk at 2.5 mg of prednisone daily over 3 months. This risk appears to be independent of bone densitometry results, in contradiction with published guidelines. With the creation of our Department of Musculoskeletal Medicine, we wanted to edict clear recommendations for the prevention of steroid-induced osteoporosis. In addition to the standard general measures to prevent osteoporosis and calcium and vitamin D supplementation, we advocate the use of a specific treatment for osteoporosis in all cases when the duration of corticosteroid therapy is not strictly limited and shorter than 3 months. Bisphosphonates are the treatment of choice, while the analogue of parathyroid hormone remains an alternative in cases with a very high fracture risk.

Quantitative ultrasound for the detection and management of osteoporosis.

Quantitative ultrasound (QUS) appears to be developing into an acceptable, low-cost and readily-accessible alternative to dual X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the detection and management of osteoporosis. Perhaps the major difficulty with their widespread use is that many different QUS devices exist that differ substantially from each other, in terms of the parameters they measure and the strength of empirical evidence supporting their use. But another problem is that virtually no data exist outside of Caucasian or Asian populations. In general, heel QUS appears to be most tested and most effective. Some, but not all heel QUS devices are effective assessing fracture risk in some, but not all populations, the evidence being strongest for Caucasian females > 55 years old, though some evidence exists for Asian females > 55 and for Caucasian and Asian males > 70. Certain devices may allow to estimate the likelihood of osteoporosis, but very limited evidence exists supporting QUS use during the initiation or monitoring of osteoporosis treatment. Likely, QUS is most effective when combined with an assessment of clinical risk factors (CRF); with DXA reserved for individuals who are not identified as either high or low risk using QUS and CRF. However, monitoring and maintenance of test and instrument accuracy, precision and reproducibility are essential if QUS devices are to be used in clinical practice; and further scientific research in non-Caucasian, non-Asian populations clearly is compulsory to validate this tool for more widespread use.

When nightclub security agents assault clients.

In 2006, a medico-legal consultation service devoted to adult victims of interpersonal violence was set up at the Lausanne University Hospital Centre, Switzerland: the Violence Medical Unit. Most patients are referred to the consultation by the Emergency Department. They are received by forensic nurses for support, forensic examination (in order to establish medical report) and community orientation. Between 2007 and 2009, among community violence, aggressions by security agents of nightclubs on clients have increased from 6% to 10%. Most of the victims are young men who had drunk alcohol before the assault. 25.7% presented one or several fractures, all of them in the head area. These findings raise questions about the ability of security agents of nightclubs to deal adequately with obviously risky situations and ensure client security.

Control of landslide retrogression by discontinuities: Evidence by the integration of airbone- and ground-based geophysical information

The objective of this work is to present a multitechnique approach to define the geometry, the kinematics, and the failure mechanism of a retrogressive large landslide (upper part of the La Valette landslide, South French Alps) by the combination of airborne and terrestrial laser scanning data and ground-based seismic tomography data. The advantage of combining different methods is to constrain the geometrical and failure mechanism models by integrating different sources of information. Because of an important point density at the ground surface (4. 1 points m?2), a small laser footprint (0.09 m) and an accurate three-dimensional positioning (0.07 m), airborne laser scanning data are adapted as a source of information to analyze morphological structures at the surface. Seismic tomography surveys (P-wave and S-wave velocities) may highlight the presence of low-seismic-velocity zones that characterize the presence of dense fracture networks at the subsurface. The surface displacements measured from the terrestrial laser scanning data over a period of 2 years (May 2008?May 2010) allow one to quantify the landslide activity at the direct vicinity of the identified discontinuities. An important subsidence of the crown area with an average subsidence rate of 3.07 m?year?1 is determined. The displacement directions indicate that the retrogression is controlled structurally by the preexisting discontinuities. A conceptual structural model is proposed to explain the failure mechanism and the retrogressive evolution of the main scarp. Uphill, the crown area is affected by planar sliding included in a deeper wedge failure system constrained by two preexisting fractures. Downhill, the landslide body acts as a buttress for the upper part. Consequently, the progression of the landslide body downhill allows the development of dip-slope failures, and coherent blocks start sliding along planar discontinuities. The volume of the failed mass in the crown area is estimated at 500,000 m3 with the sloping local base level method.

Conditions pour la consolidation de la paix en Côte d'Ivoire. Rapport narratif du séminaire Abidjan, septembre 2010.

Aquesta relatoria correspon al seminari internacional “Conditions pour la consolidation de la Paix en Côte d’Ivoire” coorganitzat per l’Institut Català Internacional per la Pau, el Centre de Recherche et Action pour la Paix (CERAP), l’Université de Bouaké, i la missió del PNUD a Costa d’Ivori, que es va realitzar a Abidjan entre el 27 i el 29 de setembre de 2010. La situació al país en el moment de la realització del seminari era difícil davant la celebració d’eleccions presidencials pocs mesos després. A la relatoria es recullen diferents aspectes sociopolítics que indicaven les greus fractures a les que s’enfrontava el país, així s’analitzen les qüestions relatives a la propietat de la terra, els problemes relacionats amb la nacionalitat i ciutadania ivoriana, les possibilitats de reorganització de l’estat i la situació del jovent, majoritari a la població ivoriana. Malauradament, les dificultats prèvies a les eleccions és van agreujar amb un resultat ajustat i la proclamació dels dos candidats com a guanyadors. Aquest desafortunat escenari ha fet encara més valuosa la present relatoria.

Església, poder i societat als comtats catalans d'origen carolingi (877-1010)

El projecte de recerca “Església, poder i societat als comtats catalans d'origen carolingi (877-1010)” contempla l'estudi de l'Església catalana del segle X en tots els seus vessants: com a estructura formada per diferents institucions (seus episcopals, cenobis, parròquies i esglésies-oratoris); com a conjunt de persones (clergues i laics que participen de diferent manera i amb diferent implicació dels afers eclesiàstics); en relació al poder polític-administratiu dels comtats catalans (comtes, vescomtes, senyors i altres delegats del poder i la justícia); com en relació amb els aspectes socioeconòmics i d'ordenació territorial (la gran massa de camperols, l'acaparament de terres per part dels grans propietaris, l'articulació d'un sistema de rendes, els vincles entre persones de diferents rangs, la compartimentació d'un espai creixent). Observem, doncs, que l'Església catalana altmedieval resta present en tots els àmbits de la vida i que el seu estudi permet, de retruc, un coneixement més profund i rigorós de la societat. Tot això, contextualitzat durant el segle X, a cavall entre dos períodes ben estudiats i que en ocasions l'han ennuvolat. El segle X és un període privilegiat per a l'estudi d'un bon nombre de dinàmiques polítiques, socials, econòmiques i culturals que demostren que aquesta centúria tenia una personalitat pròpia i que la posen en rellevància respecte als temps anteriors i posteriors. La historiografia tradicional altmedieval catalana tendeix a buscar l'origen dels canvis socials, institucionals i polítics, de la Catalunya medieval, en dos moments concrets: el món carolingi o els anys immediatament posteriors al canvi de mil•lenni. No obstant això, l'augment de fonts històriques, el millor coneixement dels conceptes i de les institucions i l'apropament a la història mitjançant nous enfocaments i paradigmes, permet visualitzar el segle X com a moment de continuació, però també de naixement de situacions prou importants com per a no ser negligides.

Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women.

SUMMARY: In a randomly selected cohort of Swiss community-dwelling elderly women prospectively followed up for 2.8 +/- 0.6 years, clinical fractures were assessed twice yearly. Bone mineral density (BMD) measured at tibial diaphysis (T-DIA) and tibial epiphysis (T-EPI) using dual-energy X-ray absorptiometry (DXA) was shown to be a valid alternative to lumbar spine or hip BMD in predicting fractures. INTRODUCTION: A study was carried out to determine whether BMD measurement at the distal tibia sites of T-EPI and T-DIA is predictive of clinical fracture risk. METHODS: In a predefined representative cohort of Swiss community-dwelling elderly women aged 70-80 years included in the prospective, multi-centre Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture risk (SEMOF) study, fracture risk profile was assessed and BMD measured at the lumbar spine (LS), hip (HIP) and tibia (T-DIA and T-EPI) using DXA. Thereafter, clinical fractures were reported in a bi-yearly questionnaire. RESULTS: During 1,786 women-years of follow-up, 68 clinical fragility fractures occurred in 61 women. Older age and previous fracture were identified as risk factors for the present fractures. A decrease of 1 standard deviation in BMD values yielded a 1.5-fold (HIP) to 1.8-fold (T-EPI) significant increase in clinical fragility fracture hazard ratio (adjusted for age and previous fracture). All measured sites had comparable performance for fracture prediction (area under the curve range from 0.63 [LS] to 0.68 [T-EPI]). CONCLUSION: Fracture risk prediction with BMD measurements at T-DIA and T-EPI is a valid alternative to BMD measurements at LS or HIP for patients in whom these sites cannot be accessed for clinical, technical or practical reasons.